Dr. Jason Lake (JL), from the Centers for Disease Control and Prevention in Atlanta, Georgia, discusses his abstract for the National Kidney Foundation’s 2016 Spring Clinical Meetings (SCM16), Improving Infection Control in Hemodialysis Centers After Acute Hepatitis C Virus Infections, with Dr. Kenar Jhaveri, AJKD Blog Editor.
AJKDblog: Why don’t you tell us a little about your research and abstract being presented at the NKF 2016 Spring Meetings?
JL: Between 2013 and 2015, the New Jersey Department of Health (NJ DOH) received reports of 16 new hepatitis C virus (HCV) infections in nine outpatient hemodialysis facilities throughout the state. This was an unusually high number of cases and a large number of affected facilities. Public health investigations conducted by NJ DOH and the Centers for Disease Control and Prevention (CDC) confirmed patient-to-patient transmission of HCV had occurred in many of the facilities, and changes to infection control practices were recommended.
The CDC later assisted NJ DOH in additional on-site infection control assessments in each facility. The following eight different procedure types were observed, and adherence to CDC-recommended infection control practices were evaluated using standard audit tools: hand hygiene, hemodialysis catheter connection and disconnection, catheter exit site care, arteriovenous fistula (AVF) and graft (AVG) cannulation, intravenous medication preparation and administration, and routine dialysis station disinfection. Across all facilities, overall hand hygiene performance (i.e., percent of times performed when indicated) was 90%. We identified important areas for improvement in other categories of infection control observations. Of 250 routine dialysis station disinfection procedures observed, 37% were performed properly. Only 42% of 36 catheter connections, 50% of 28 catheter disconnections, 59% of 105 injectable medication administrations, and 67% of 191 AVF and AVG cannulations were completed successfully. NJ DOH and the CDC provided facilities with recommendations for improvement and education in areas such as aseptic technique, injection safety, and proper disinfection procedures.
AJKDblog: Can you give us 3-4 ways to improve the infection control in end-stage renal disease patients in regards to hepatitis C?
JL: In response to the New Jersey cases and similar reports of new HCV infections from other states, the CDC released a health advisory through the Health Alert Network, encouraging dialysis providers to do the following:
- Assess current infection control practices and environmental cleaning and disinfection practices within the facility to ensure adherence to infection control standards;
- Address any gaps identified by the assessments;
- Screen patients for HCV following CDC guidelines to detect infections, determine treatment potential, and halt secondary transmission; and
- Promptly report all acute HCV infections to the state or local health department.
Transmission of HCV to patients in the dialysis setting is preventable. When HCV transmission occurs in this setting, it demonstrates a larger infection control problem. Bolstering a facility’s infection control policies and practices to prevent such transmission from occurring is the best course of action. Infection control resources and CDC-recommended best practices for HCV and other blood borne pathogens can be found at http://www.cdc.gov/dialysis/. Becoming familiar with these resources and routinely using them in your dialysis center is a great start.
AJKDblog: Where do you and your group go from here?
JL: Since our site visits, NJ DOH has provided each facility with a written report with recommendations from the infection control practice observations. The state is in the process of following up with the facilities to learn about changes made to practices and to offer additional recommendations where needed. NJ DOH has also targeted a number of other dialysis facilities in the state for infection control assessments to help them improve their routine infection control practices. Close collaboration between dialysis providers and public health departments can be mutually beneficial and is underutilized. The CDC is supporting several initiatives to encourage collaboration between public health and dialysis providers. Ideally we’ll see more of these interactions in the near future.
All Spring Clinical Meeting abstracts are available in the May issue of AJKD.